Pharmacology Flashcards Preview

Step 1 boards > Pharmacology > Flashcards

Flashcards in Pharmacology Deck (238)
1

Km

Potency. It is inversely related to the affinity of the enzymes for its substrate. Km= [S] at 1/2 Vmax. The high Km, the lower the affinity.

2

Vmax

Efficacy. Vmax represents the maximum rate achieved by the system, at maximum (saturating) substrate concentrations.

3

Michaelis-Menten kinetics

Enzymatic reactions that follow a hyperbolic curve when velocity is plotted against [S]. Enzymatic reactions that exhibit a sigmoid curve usually indicate cooperative kinetics (ie hemoglobin).

4

Lineweaver-Burk plot

1/V plotted against 1/[S]. Y-intercept= 1/Vmax, an increase in the y-intercept = a decrease in Vmax. X-intercept= -1/Km, the closer to zero, the bigger Km is and the smaller affinity is.

5

Competitive reversible inhibitors

There structure resembles the substrate and binds active site of the enzyme. It can be over come by an increase in [S]. There is no effect on Vmax. It increases Km, which decreases the potency.

6

Competitive irreversible inhibitors

There structure resembles the substrate but does not bind the active site of the enzyme. It can not be over come by an increase in [S]. It decreases Vmax, which decreases efficacy. There is no effect on Km.

7

Noncompetitive inhibitors

They do not resemble substrate and do not bind the active site. It can not be overcome with an increase in [S]. It decreases Vmax, which decreases efficacy. There is no effect on Km.

8

Bioavailability (F)

Fraction of administered drug reaching systemic circulation unchanged. For an IV dose, F=100%. Orally, F is less than 100% due to incomplete absorption and first pass metabolism.

9

Volume of distribution (Vd)

Theoretical volume occupied by the total amount of drug in the body relative to its plasma concentration. Apparent Vd of plasma protein-bound drugs can be altered by liver and kidney disease (a decrease in protein binding leads to an increase in Vd). Drugs may distribute in more than one compartment. Vd=amount of drug in the body/ plasma drug concentration.

10

Low Vd

Usually the compartment is blood. Drug types are usually large/ charged molecules and plasma bound.

11

Medium Vd

Usually the compartment is ECF. Drug types are small hydrophilic molecules.

12

High Vd

Usually can saturate all tissues, including fat. Drug types are usually small lipophilic molecules, especially if bound to tissue protein.

13

Clearance (CL)

The volume of plasma cleared of drug per unit time. Clearance may be impaired with defects in cardiac, hepatic, or renal function. CL= rate of elimination of drug/ plasma drug concentration= Vd x Ke (elimination constant).

14

Half-life (t1/2)

The time required to change the amount of drug in the body by 1/2 during elimination (or constant infusion). Property of first order elimination. A drug infused at a constant rate takes 4-5 half-lives to reach a steady state. It takes 3.3 half lives to reach 90% of the steady state level. t1/2=(0.693 x Vd)/ CL. Time to steady state depends primarily on t1/2 and is independent of dose and dosing frequency.

15

Loading dose

Loading dose= (Cp x Vd)/F. Cp= target plasma concentration at steady state.

16

Maintenance dose

Maintenance dose= (Cp x CL x t)/ F. Cp=target dose, CL= clearance, t= dosage interval (time between doses), if not administered continuously. Cp= target plasma. In renal or liver disease, maintenance dose decreases and loading dose is usually unchanged.

17

Zero- order elimination

Rate of elimination is constant regardless of Cp (target plasma); constant amount of drug eliminated per unit of time. Cp decreases linearly with time. Examples of drugs include (PEA- round haped like the 0 in zero-order) Phenytoin, Ethanol, and Aspirin (at high or toxic concentrations). Capacity limited elimination.

18

First order elimination

Rate of elimination is directly proportional to the drug concentration (ie constant fraction of drug eliminated per unit of time). Cp decreases exponentially with time. It is flow dependent elimination.

19

Urine pH and drug elimination

Ionized species are trapped in urine and cleared quickly. Neutral forms can be reabsorbed. Weak acids, such as phenobarbital, methotrexate, aspirin and TCAs, get trapped in basic environment. Therefore you can treat overdoses with bicarbonate. Weak bases include amphetamines, which get trapped in acidic environments. Treat overdose with ammonium chloride.

20

Phase I drug metabolism

Reduction, oxidation, hydrolysis with cytochrome P-450 usually yield slightly polar, water-soluble metabolites (often still active). Geriatric patients lose phase I first.

21

Phase II drug metabolism

Conjugation (Glucuronidation, Acetylation, Sulfation- GAS) usually yields very polar, inactive metabolites (renally excreted). Patients who are slow acetylators have an increase in side effects from certain drugs because of a decrease in rate of metabolism.

22

Efficacy

The maximal effect a drug can produce. It is represented by the y-value (Vmax). It is unrelated to potency (ie efficacious drugs can have high or low potency). Partial agonists have less efficacy than full agonists.

23

Potency

The amount of drug needed for a given effect. An increase in potency (EC50-the concentration of a drug that gives half-maximal response)= a decrease in potency. Unrelated to efficacy (ie potent drugs can have a high or low efficacy).

24

Competitive antagonist

They shifts curve right (a decrease in potency, Km), no change in efficacy. Can be overcome by an increase in the concentration of agonist substrate. For example, diazepam is an agonist, while flumazenil is a competitive antagonist on the GABA receptor.

25

Noncompetitive antagonist

They shift the curve down, a decrease in efficacy. It cannot be overcome by an increase in agonist substrate concentration. For example, norepinephrine is an agonist, while phenoxybenzamine is a noncompetitive antagonist on alpha receptors.

26

Partial agonist (alone)

They act at the same site as a full agonist, but with lower than maximal effect, which is a decrease in efficacy (Vmax). Potency is an independent variable. For example, morphine is a full agonist, while buprenorphine is a partial agonistat opiod at mu-receptors.

27

Therapeutic index

A measurement of drug safety. TD50/ED50=median toxic dose/median effective dose= therapeutic index. Safer drugs have a higher TI value. Drugs with a lower TI value include digoxin, lithium, theophylline, and warfarin. LD50 (lethal median dose) often replaces TD50 in animal studies.

28

Therapeutic window

A measure of clinical drug effectiveness for a patient.

29

Botulinum toxin

prevents the release of acetylcholine at cholinergic terminals.

30

Nicotinic ACh receptors

They are ligand gated Na/K channels. Subtypes include Nn (found in autonomic ganglia) and Nm (found in neuromuscular junction).

31

Voluntary motor nerve

It is a somatic nerve. Lower motor neurons synapse on skeletal muscles, releasing the neurotransmitter acetylcholine, which synapse on nicotinic receptors.

32

Muscarinic ACh preceptos

They are G protein coupled receptors that usually act through secondary messengers. The 5 subtypes include M1, M2, M3, M4, and M5.

33

alpha-1 androgenic receptors

It is a Gq-protein linked 2nd messengers. It increases vascular smooth muscle contraction, increases pupillary dilator muscle contraction (mydriases), increases intestinal and bladder sphincter muscle contraction.

34

alpha-2 androgenic receptors

It is a Gi-protein linked 2nd messengers. It decreases sympathetic outflow, decreases insulin release, decreases lipolysis. increases platelet aggregation, and decreases aqueous humor production.

35

beta-1 androgenic receptors

It is a Gs-protein linked 2nd messengers. It increases heart rate, increases contractility, increases renin release, and increases lipolysis

36

beta-2 androgenic receptors

It is a Gs-protein linked 2nd messengers. It causes vasodilation, causes bronchodilation, increases lipolysis, increases insulin release, decreases uterine tone (tocolysis), causes ciliary muscle relaxation, and increases aqueous humor production

37

M1 receptors

It is a Gq-protein linked 2nd messengers. It is located in the CNS and in the enteric nervous system.

38

M2 receptors

It is a Gi-protein linked 2nd messengers. It decreases heart rate and contractility of atria.

39

M3 receptors

It is a Gq-protein linked 2nd messengers. It increases exocrine gland secretions (eg lacrimal, salivary, gastric acid), increases gut peristalsis, increases bladder contraction, causes bronchoconstriction, increases pupillary sphincter muscle contraction (miosis), causes ciliary muscle contraction (accommodation).

40

D1 receptors

It is a Gs-protein linked 2nd messengers. It relaxes renal vascular smooth muscle.

41

D2 receptors

It is a Gi-protein linked 2nd messengers. It modulates transmitter releases, especially in the brain.

42

H1 receptors

It is a Gq-protein linked 2nd messengers. It increases nasal and bronchial mucus production, increases vascular permeability, causes contraction of bronchioles, causes pruritus, and causes pain.

43

H2 receptors

It is a Gs-protein linked 2nd messengers. It increases gastric acid secretion.

44

V1 receptors

It is a Gq-protein linked 2nd messengers. It increases vascular smooth muscle contraction.

45

V2 receptors

It is a Gs-protein linked 2nd messengers. It increases H2O permeability and reabsorption in collecting tubules of the kidney (V2 found in 2 kidneys).

46

Gq receptors

H1, alpha1, V1, M1, M3 (HAVe 1 M&M, or 3). Binding the receptor activates phospholipase C, which cleaves PIP2 into DAG (which activates protein kinase C) and IP3 (which increases Ca, leading to smooth muscle contraction).

47

Gs receptors

beta1, beta2, D1, H2, V2. Gs activates adenyly cyclase, turning ATP to cAMP, which activates Protein kinase A, increasing Ca concentration (in the heart) and activating myosin light-chain kinase (in smooth muscle).

48

Gi receptors

M2, alpha2, D2 (MAD 2's). Gi inhibits adenyly cyclase, reducing cAMP, inhibiting protein kinase A, decreasing Ca concentration (in the heart) and inhibiting myosin light-chain kinase (in smooth muscle).

49

Anticholinergic drug that inhibit choline reuptake in the presynaptic neuron

Hemicholinium

50

Anticholinergic drug that inhibit ACh uptake into vesicles in the presynaptic neuron

Vesamicol

51

Anticholinergic drug that inhibit ACh release from presynaptic neuron

Botulinum

52

Cholinergic drug that inhibit break down of ACh in synaptic cleft

ACh esterase inhibitors

53

Antiadrenergic drug that inhibits the conversion of tyrosine to DOPA in presynaptic neurons

Metryosine

54

Antiadrenergic drug that inhibits vesicular transport of norepinephrine, serotonin, and dopamine in presynaptic neurons

Reserpine

55

Antiadrenergic drug that blocks the release of noradrenaline from nerve terminals in presynaptic neurons

Bretylium

56

Antiadrenergic drug that reduces the release of catecholamines from nerve terminals in presynaptic neurons

Guanethidine

57

Adrenergic drugs that induce amphetamine and ephedrine from nerve terminals in presynaptic neurons

Amphetamine and ephedrine

58

Antiadrenergic drug that inhibit reuptake of catacholines into presynaptic neurons

Cocaine, TCAs, and amphetamine

59

Modulation of norepinephrine release from sympathetic nerve endings

It is inhibited by norepinephrine itself, acting on presynaptic alpha2- receptors

60

Bethanechol

Used for postoperative ileus, neurogenic ileus, and urinary retention. Direct cholinergic agonist. It activates Bowel and Bladder smooth muscle; resistant to AChE. (Bethany, call (bethanechol) me to activate your Bowels and Bladders)

61

Carbachol

Direct cholinergic agonist. Constricts pupil and relieves intraocular pressure in glaucoma. CARBon copy of acetylCHOLine

62

Methacholine

Direct cholinergic agonist. Challenge test for diagnosis of asthma. Stimulates Muscarinic receptors in airway when inhaled.

63

Pilocarpine

Direct cholinergic agonist. Potent stimulator of sweat, tears, and saliva. Used to treat both open angle and closed angle glaucoma. It contracts ciliary muscle of the eye (open angle glaucoma), pupillary sphincter (closed angle glaucoma). It is resistant to AChE. (You cry, drool, and sweat on your PILOw)

64

Donepezil

Anticholinesterases (indirect agonists). Used to treat Alzheimer disease. Increases ACh.

65

Galantamine

Anticholinesterases (indirect agonists). Used to treat Alzheimer disease. Increases ACh.

66

Rivastigmine

Anticholinesterases (indirect agonists). Used to treat Alzheimer disease. Increases ACh.

67

Edrophonium

Anticholinesterases (indirect agonists). Historically, used to diagnosis of myasthenia gravis (extremely short acting). Myasthenia now diagnosed by anti-AChR Ab (anti-acetylcholine receptor antibody) test. Increases ACh.

68

Neostigmine

Anticholinesterases (indirect agonists). Postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade (postoperative). Increases ACh. Neo CNS= No CNS penetration.

69

Physostigmine

Anticholinesterases (indirect agonists). Can cause anticholinergic toxicity; it can cross blood-brain barrier into the CNS. Increases ACh. PHYsostigmine "PHYxes" atropine overdose.

70

Pyridostigmine

Anticholinesterases (indirect agonists). Myasthenia gravis (long acting); does not penetrate CNS. Increases ACh; increases muscle strength. PyRIDostiGMine gets RID of Myasthenia Gravis.

71

Toxicity of all cholinomimetic agents

Watch for exacerbation of COPD, asthma, and peptic ulcers when treating susceptible patients.

72

Cholinesterase inhibitor poisoning

Often due to to organophosphates, such as parathion, that irreversible inhibit AChE. Causes Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation. DUMBBELSS. Organophosphates are often components of insecticides; poisoning usually seen in farmers.

73

Treatment of cholinesterase inhibitor poisoning

Atropine (competitive inhibitor) plus pralidoxime (regenerates AChE if given early).

74

Atropine

Muscarinic antagonists. Targets the eye. Produces mydriasis and cycloplegia.

75

Homatropine

Muscarinic antagonists. Targets the eye. Produces mydriasis and cycloplegia.

76

Tropicamide

Muscarinic antagonists. Targets the eye. Produces mydriasis and cycloplegia.

77

Benztropine

Muscarinic antagonists. Targets the CNS. Treats PARKinson disease (PARK my BENZ). Also treats acute dystonia.

78

Glycopyrrolate

Muscarinic antagonists. Targets the GI and respiratory systems. It is used parenterally, preoperatively, to reduce airway secretions. It is also used orally, to reduce drooling and peptic ulcer.

79

Hyoscyamine

Muscarinic antagonists. Targets the GI system. It is used as an antispasmodics for irritable bowel syndrome.

80

Dicyclomine

Muscarinic antagonists. Targets the GI system. It is used as an antispasmodics for irritable bowel syndrome.

81

Ipratropium

Muscarinic antagonists. Targets the respiratory system. Used to treat COPD, asthma (I PRAy i can breathe soon!)

82

Tiotropium

Muscarinic antagonists. Targets the respiratory system. Used to treat COPD, asthma.

83

Oxybutynin

Muscarinic antagonists. Targets the genitourinary system. It reduces bladder spasms and urge urinary incontinence (overactive bladder).

84

Solifenacin

Muscarinic antagonists. Targets the genitourinary system. It reduces bladder spasms and urge urinary incontinence (overactive bladder).

85

Tolterodine

Muscarinic antagonists. Targets the genitourinary system. It reduces bladder spasms and urge urinary incontinence (overactive bladder).

86

Scopolamine

Muscarinic antagonists. Targets the CNS system. It used to treat motion sickness.

87

Atropine

Muscarinic antagonist. Used to treat bradycardia and for ophthalmic applications. It blocks DUMBBeLSS. Skeletal muscle and CNS excitation is mediated by nicotinic receptors. In the eyes, it increases pupil dilation and increases cycloplegia (paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation). In the airway, it decreases secretions. In the stomach, it decreases acid secretions. In the gut, it decreases motility. In the bladder, it decreases urgency in cystitis.

88

Toxicity of atropine

Causes an increase in body temperature (due to a decrease in sweating); rapid pulse; dry mouth; dry, flushed skin; cycloplegia; constipation; disorientation. Can cause acute angle-closure glaucoma in elderly (due to mydriasis), urinary retention in men with prostatic hyperplasia, and hyperthermia in infants. Hot as a hare, dry as a bone, red as a beet, blind as a bat, and mad as a hatter. Jimson weed (Datura) causes gardener's pupil (mydriasis due to plant alkaloids).

89

Tetrodotoxin

It is a highly potent toxin that binds fast voltage-gated Na channels in cardiac and nerve tissue, preventing depolarization (blocks action potential without changing resting potential). It causes nausea, diarrhea, paresthesias, weakness, dizziness, and loss of reflexes. Poisoning can result from ingestion of poorly prepared pufferfish (fugu), a delicacy in Japan. Treatment is primarily supportive.

90

Ciguatoxin

It causes ciguatera fish poisoning. It opens Na channels causing depolarization. Symptoms easily confused with cholinergic poisoning. Temperature-related dysesthesia (eg cold feels hot; hot feels cold) is a specific finding of ciguatera. It is caused by consumption of reef fish (eg barracuda, snapper, moray eel). Treatment is primarily supportive.

91

Scombroid poisoning

It is caused by consumption of dark-meat fish (eg bonito, mackerel, mahi-mahi, tuna) improperly stored at warm temperature. Bacterial histidine decarboxylase converts histidine to histamine. Histamine is not degraded by cooking. It is frequently misdiagnosed as an allergy to fish. It causes acute-onset burning sensation of the mouth, flushing of face, erythema, urticaria, pruritus, and headache. It may cause anaphylaxis-like presentation (ie bronchospasm, angioedema, hypotension). It is treated supportively with antihistamines; if needed, antianaphylactics (eg bronchodilators and epinephrine).

92

Albuterol

Direct sympathomimetics. Acts on beta2 more than beta1. Albuterol is used for acute asthma.

93

Salmeterol

Direct sympathomimetics. Acts on beta2 more than beta1. It is used for long term asthma and COPD control.

94

Dobutamine

Direct sympathomimetics. Acts on beta1 more than beta2 and alpha receptors. It is used to treat heart failure (inotropic- contraction more than chronotropic- HR), and cardiac stress test.

95

Epinephrine

Direct sympathomimetics. Acts on beta more than alpha receptors. It is used to treat anaphylaxis, asthma, open-angle glaucoma; alpha effects predominate at high doses. Significantly stronger effect at beta2 receptor than norepinephrine.

96

Dopamine

Direct sympathomimetics. Acts on D1 and D2 more than beta more than alpha. It is used to treat unstable bradycardia, HF, shock; inotropic and chronotropic alpha effects predominate at high doses.

97

Isoproterenol

Direct sympathomimetics. Acts on beta 1 and beta 2 equally. It is used for electrophysiologic evaluation of tachyarrhythmias. Can worsen ischemia.

98

Norepinephrine

Direct sympathomimetics. Acts on alpha 1 more than alpha 2 more than beta 1. It is used to treat hypotension (but decreases renal perfusion). It has significantly weaker effect at beta 2 receptor than epinephrine.

99

Phenylephrine

Direct sympathomimetics. Acts on alpha1 more than alpha2. Used to treat hypotension (vasoconstriction), for ocular procedures (mydriatic), and to treat rhinitis (decongestant).

100

Amphetamine

Indirect sympathomimetics. It as indirect general agonist, reuptake inhibitor, also releases stored catecholamines. It is used to treat narcolepsy, obesity, and ADHD.

101

Cocaine

Indirect sympathomimetics. It as indirect general agonist, reuptake inhibitor. It causes vasoconstriction and local anesthesia. Never give a beta blocker if there is a cocaine intoxication is suspected (can lead to unopposed alpha1 activation and extreme hypertension).

102

Ephedrine

Indirect sympathomimetics. It as indirect general agonist, releases stored catecholamines. It is used to treat nasal decongestion, urinary incontinence, and hypotension.

103

Norepinephrine vs isoproterenol

Norepinephrine increases systolic and diastolic pressures as a result of alpha-1 mediated vasoconstriction, leading to an increase in mean arterial pressure, which causes reflex bradycardia. However, isoproterenol (no longer commonly used) has little alpha effect but causes beta-2 mediated vasodilation, resulting in a decrease in mean arterial pressure and an increase in heart rate through beta-1 and reflex activity.

104

Clonidine applications

Sympatholytics (alpha2 agonists). It is used for hypertensive urgency (limited situations); it does not decrease renal blood flow. It is also used to treat ADHD and tourette syndrome. Toxicities include CNS depression, bradycardia, hypotension, respiratory depression, and miosis.

105

alpha methyldopa

Sympatholytics (alpha2 agonists). It is used for hypertension in pregnancy. Toxicities direct Coombs positive hemolysis, SLE-like syndrome.

106

Phenoxybenzamine

Irreversible alpha blocker. Used to treat pheochromocytoma (used preoperatively) to prevent catecholamine (hypertensive) crisis. Side effects include orthostatic hypotension and reflex tachycardia.

107

Phentolamine

Reversible alpha blocker. Used to give to patients on MAO inhibitors who eat tyramine containing foods. Side effects include orthostatic hypotension and reflex tachycardia.

108

Prazosin

Alpha 1 selective blocker. It is used for urinary symptoms of BPH; it is also used to treat PTSD and hypertension. Side effects include 1st dose orthostatic hypotension, dizziness, and headache.

109

Terazosin

Alpha 1 selective blocker. It is used for urinary symptoms of BPH. Side effects include 1st dose orthostatic hypotension, dizziness, and headache.

110

Doxazosin

Alpha 1 selective blocker. It is used for urinary symptoms of BPH; it is also used to treat hypertension. Side effects include 1st dose orthostatic hypotension, dizziness, and headache.

111

Tamsulosin

Alpha 1 selective blocker. It is used for urinary symptoms of BPH; it is also used to treat hypertension. Side effects include 1st dose orthostatic hypotension, dizziness, and headache.

112

Mirtazapine

Alpha 2 selective blocker. It is used to treat depression. Side effects include sedation, an increase in serum cholesterol, and an increase appetite.

113

alpha blockade with epinephrine vs phenylephrine

When an alpha blockage is given after epinephrine or phenylephrine. The epinephrine response exhibits reversal of the mean blood pressure changes, from a net increase (the alpha response) to a net decrease (the beta2 response). The response to phenylephrine is suppressed but not reversed because phenylephrine is a pure alpha agonist without beta action.

114

Beta blockers

Acebutolol, atenolol, betaxolol, carvedilol, esmolol, labetalol, metoprolol, nadolol, nebivolol, pindolol, timolol.

115

Beta blockers application towards angina pectoris

beta blockers decrease heart rate and contractility, resulting in a decrease in O2 consumption.

116

Beta blockers application towards MI

Beta blockers (metoprolol, carvedilol, and bisoprolol) decreases mortality.

117

Beta blockers application towards supraventricular tachycardia

Metoprolol and esmolol decrease AV conduction velocity (class II antiarrhythmic)

118

Beta blockers application towards hypertension

They decrease cardiac output, decrease renin secretion (due to beta1 receptor blockade on JGA cells)

119

Beta blockers application towards heart failure

they decrease chronic HF

120

Beta blockers application towards glaucoma

timolol decreases secretion of aqueous humor.

121

Toxicity of beta blockers

They can cause impotence, cardiovascular adverse effects (bradycardia, AV block, HF), CNS adverse effects (seizures, sedation, and sleep alterations), dyslipidemia (metoprolol), and asthma/COPD exacerbations. Avoid in cocaine users due to risk of unopposed alpha adrenergic receptor agonist activity. Despite theoretical concern of masking hypoglycemia in diabetics, benefits likely outweigh risks and is not containdicated.

122

beta1 antagonists

Acebutolol (partial agonist), atenolol, betaxolol, esmolol, metroprolol. Selective antigonists mostly go from A to M (Beta 1 with the 1st half of the alphabet)

123

Nonselective beta agonists

Nadolol, pindolol (partia agonist), propranolol, timolol. Nonseletive antagonists mostly go from N to Z.

124

Carvedilol

Nonselective alpha and beta antagonists.

125

Labetalol

Nonselective alpha and beta antagonists.

126

Nebivolol

Combines cardiac selective beta1 adrenergic blockade with stimulation of beta3 receptors, which activate nitric oxide synthase in the vasculature.

127

Antidote for acetaminophen overdose

N-acetylcysteine (replenishes glutathione)

128

Antidote for AChE inhibitors and organophosphates overdose

Atropine works better than pralidoxime

129

Antidote for amphetamines (basic) overdose

NH4Cl acidifies the urine

130

Antidote for antimuscarinic and anticholinergic overdose

Physostigmine salicylate and control hyperthermia

131

Antidote for benzodiazepines overdose

Flumazenil

132

Antidote for beta-blockers overdose

glucagon

133

Antidote for carbon monoxide overdose

100% O2, hyperbaric O2

134

Antidote for coper overdose

Penicillamine

135

Antidote for arsenic overdose

Penicillamine

136

Antidote for gold overdose

Penicillamine

137

Antidote for cyanide overdose

Nitrate plus thiosulfate or hydroxocobalamin

138

Antidote for digitalis (digoxin) overdose

Anti-dig Fab fragments

139

Antidote for heparin overdose

Protamine sulfate

140

Antidote for iron overdose

DFEroxamine or deFErasirox

141

Antidote for lead overdose

EDTA, dimercaprol, succimer, or penicillamine

142

Antidote for mercury overdose

DiMERCaprol (BAL) or succimer

143

Antidote for arsenic overdose

Dimercaprol (BAL) or succimer

144

Antidote for gold overdose

Dimercaprol (BAL) or succimer

145

Antidote for methanol or ethylene glycol (antifreeze) overdose

Fomepizole works better than ethanol. Dialysis is also an option.

146

Antidote for methemoglobin overdose

METHyleneblue or vitamin C

147

Antidote for opioids overdose

Naloxone or naltrexone

148

Antidote for salicylates overdose

NaHCO3 (alkalinize urine) or dialysis

149

Antidote for TCAs overdose

NaHCO3 (plasma alkalinization)

150

Antidote for tPA overdose

Aminocaproic acid

151

Antidote for streptokinase overdose

Aminocaproic acid

152

Antidote for urokinase overdose

Aminocaproic acid

153

Antidote for warfarin overdose

Vitamin K (delayed effect) or fresh frozen plasma (immediate effect)

154

Drug reactions causing coronary vasospasm

Cocaine, sumatriptan, ergot alkaloids

155

Drug reactions causing cutaneous flushing

Vancomycin, Adenosine, Niacin, Ca channel blockers (VANC)

156

Drug reactions causing dilated cardiomyopathy

Anthracyclines (eg doxorubicin, daunorubicin), can be prevented with dxrazoxane

157

Drug reactions causing torsades de pointes

Class III (eg sotalol) and class IA (eg quinidine) antiarrhythmics, macrolide antibiotics, antipsychotics, TCAs

158

Drug reactions causing adrenocortical insufficiency

Hypothalamic–pituitary–adrenal axis (HPA axis) secondary to glucocorticoid withdrawal.

159

Drug reactions causing hot flashes

Tamoxifen, clomiphene

160

Drug reactions causing hyperglycemia

Tacrolimus, Protease inhibitors, Niacin, Hydrochlorothiazide (HCTZ), Corticosteroids (Taking Pills Necessitates Having blood Checked)

161

Drug reactions causing hypothyroidism

Lithium, amiodarone, sulfonamides

162

Drug reactions causing acute cholestatic hepatitis and jaundice

Erthromycin

163

Drug reactions causing diarrhea

Metformin, Erythromycin, Colchicine, Orlistat, Acarbose (Might Excite Colon On Accident)

164

Drug reactions causing focal to massive hepatic necrosis

Halothane, Amanita phalloides (death cap mushroom), Valproic acid, Acetaminophen (liver HAVAc)

165

Drug reactions causing hepatitis

Rifampin, isoniazid, pyrazinamide, statins, fibrates.

166

Drug reactions causing pancreatitis

Didanosine, Corticosteroids, Alchol, Valproic acid, Azathioprine, Diuretics (furosemide, HCTZ) (Drugs Causing A Violent Abdominal Distress)

167

Drug reactions causing pseudomembranous colitis

Clindamycin, ampicillin, caphalosporins. (antibiotics predispose to superinfection by resistant C difficle.

168

Drug reactions causing agranulocytosis

Ganciclovir, Clozapine, Carbamazepine, Colchicine, Methimazole, Propylthiouracil (Gangs CCCrush Myeloblasts and Promyelocytes)

169

Drug reactions causing aplastic anemia

Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol, Propylthiouracil (Can't Make New Blood Cells Properly)

170

Drug reactions causing direct Coombs-positive hemolytic anemia

Methylodopa, penicillin

171

Drug reactions causing gray baby syndrome

Chloramphenicol

172

Drug reactions causing hemolysis in G6PD deficiency

Isoniazid, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin (hemolysis IS D PAIN)

173

Drug reactions causing megaloblastic anemia

Phenytoin, Methotrexate, Sulfa drugs (Having a blast with PMS)

174

Drug reactions causing thrombocytopenia

Heparin

175

Drug reactions causing thrombotic complications

OCPs, hormone replacement therapy

176

Drug reactions causing fat redistribution

Protease Inhibitors, Glucocorticoids (Fat PIG)

177

Drug reactions causing gingival hyperplasia

Phenytoin, Ca channel blockers, cyclosporine

178

Drug reactions causing hyperuricemia (gout)

Pyrazinamide, Thiazides, Furosemide, Niacin, Cyclosporine (Painful Tophi and Feet Need Care)

179

Drug reactions causing myopathy

Fibrates, niacin, colchicine, hydroxychloroquine, interferon-alpha, penicillamine, statins, glucocorticoids

180

Drug reactions causing osteoporosis

Corticosteroids, heparin

181

Drug reactions causing photosensitivity

Sulfonamides, Amiodarone, Tetracyclines, 5-FU (SAT for Foto)

182

Drug reactions causing Stevens-Johnson syndrome

Anti-epileptic drugs (especially lamotrigine), allopurinol, sulfa drugs, penicillin. (Steven Johnson has epileptic ALLergy to sulfa drugs and penicillin)

183

Drug reactions causing SLE-like syndrome

Sulfa drugs, Hydralazine, Isoniazid, Procainamide, Phenytoin, Etanercept (having lupus is "SHIPP-E"

184

Drug reactions causing teeth discoloration

tetracyclines

185

Drug reactions causing tendonitis, tendon rupture, and cartilage damage

Fluoroquinolones

186

Drug reactions causing cinchonism

Quinidine, quinine

187

Drug reactions causing parkinson-like syndrome

Antipsychotics, Reserpine, Metoclopramide (cogwheel rigidity of ARM)

188

Drug reactions causing seizures

Isoniazid (due to vitamin B6 deficiency), Bupropion, Imipenem/cilastatin, Enflurane (With seizures, I BItE my tongue)

189

Drug reactions causing tardive dyskinesia

Antipsychotics, metoclopramide

190

Drug reactions causing diabetes insipidus

Lithium, demeclocycline

191

Drug reactions causing Fanconi syndrome

Expired tetracycline

192

Drug reactions causing hemorrhagic cystitis

Cyclophosphamide, ifosfamide (prevent by coadministering with mesna)

193

Drug reactions causing interstitial nephritis

Methicillin, NSAIDs, furosemide

194

Drug reactions causing SIADH

Carbamazepine, Cyclophosphamide, SSRIs (Can't Concentrate Serum Sodium)

195

Drug reactions causing dry cough

ACE inhibitors

196

Drug reactions causing pulmonary fibrosis

Bleomycin, Amiodarone, Busulfan, Methotrexate (Breathing Air Badly from Medications)

197

Drug with antimuscarinic reactions

Atropine, TCAs, H1-blockers, antipsychotics

198

Drug reactions causing a disulfiram like reaction

Metronidazole, certain cephalosporins, griseofulvin, procarbazine, 1st generation sulfonylureas

199

Drug reactions causing nephrotoxicity/ototoxicity

Aminoglycosides, vancomycin, loop diuretics, cisplatin. Cisplatin toxicity may respond to amifostine

200

Cytochrome P-450 inducers

Chronic alcohol use, St John's wort, Phenytoin, Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine (Chronic alcoholics STeal Phen-PHen and Never Refuse Greasy Carbs.

201

Cytochrome P-450 substrates

Anti-epileptics, Theophylline, Warfarin, OCPs (Always Think When Outdoors)

202

Cytochrome P-450 inhibitors

Acute alcohol abuse, Ritonavir, Amiodarone, Cimetidine, Ketoconazole, Sulfonamides, Isoniazid (INH), Grapefruit juice, Quinidine, Macrolides (except azithromycin) (AAA RACKS IN GQ Magazine)

203

Sulfa drugs

Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonamide antibiotics, Sulfasalazine, Sulfonylureas. (Popular FACTSSS) Patients with sulfa allergies may develop fever, urinary tract infection, Stevens-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, urticaria (hives). Symptoms range from mild to life threatening.

204

Drugs ending with -azole

Ergosterol synthesis inhibitor, eg ketoconazole

205

Drugs ending with -bendazole

Antiparasitic/antihelmintic, eg mebendazole

206

Drugs ending with -cillin

Peptidoglycan synthesis inhibitor, eg ampicillin

207

Drugs ending with -cycline

Protease synthesis inhibitor, eg tetracycline

208

Drugs ending with -ivir

Neuraminidase inhibitor, eg oseltamivir

209

Drugs ending with -navir

Protease inhibitor, eg ritonavir

210

Drugs ending with -ovir

DNA polymerase inhibitor, eg acyclovir

211

Drugs ending with -thromycin

macrolide antibiotic, eg azifthromycin

212

Drugs ending with -ane

Inhalational general anesthetic, eg halothane

213

Drugs ending with -azine

Typical antipsychotic, eg thioridazine

214

Drugs ending with -barbital

Barbiturate, eg phenobarbital

215

Drugs ending with -caine

Local anesthetic, eg lidocaine

216

Drugs ending with -etine

SSRI, eg fluoxetine

217

Drugs ending with -ipramine or -triptyline

TCA, eg imipramine, amitriptyline

218

Drugs ending with -triptan

5-HT1B/1D agonists, sumatriptan

219

Drugs ending with -zepam or -zolam

Benzodiazepine, eg diazepam or alprazolam

220

Drugs ending with -chol

Cholinergic agonist, eg bethanechol/carbachol

221

Drugs ending with -curium or -curonium

Nondepolarizing paralytic, eg atracurium, vecuronium

222

Drugs ending with -olol

beta-blocker, eg propranolol

223

Drugs ending with -stigmine

AChE inhibitor, neostigmine

224

Drugs ending with -terol

beta2-agonist, eg albuterol

225

Drugs ending with -zosin

alpha1-antagonist, eg prazosin

226

Drugs ending with -afil

PDE-5 inhibitor, eg sildenafil

227

Drugs ending with -dipine

Dihydropyridine CCB, eg amlodipine

228

Drugs ending with -pril

ACE inhibitor, eg captopril

229

Drugs ending with -sartan

Angiotensin-II receptor blocker, eg losartan

230

Drugs ending with -statin

HMG-CoA reductase inhibitor, eg atorvastatin

231

Drugs ending with -dronate

Bisphosphonate, eg alendronate

232

Drugs ending with -glitazone

PPAR-gamma activator, eg rosiglitazone

233

Drugs ending with -prazole

Proton pump inhibitor, eg omeprazole

234

Drugs ending with -prost

Prostaglandin analog, eg latanoprost

235

Drugs ending with -tidine

H2-antagonist, eg cimetidine

236

Drugs ending with -tropin

Pituitary hormone, eg somatotropin

237

Drugs ending with -ximab

Chimeric monoclonal Ab, basiliximab

238

Drugs ending with -zumab

Humanized monoclonal, eg daclizumab